Objective To determine whether there were inequalities in the sustained rise in infant mortality in England in recent years and the contribution of rising child poverty to these trends.
Design This is an analysis of trends in infant mortality in local authorities grouped into five categories (quintiles) based on their level of income deprivation. Fixed-effects regression models were used to quantify the association between regional changes in child poverty and regional changes in infant mortality.
Setting 324 English local authorities in 9 English government office regions.
Participants Live-born children under 1 year of age.
Main outcome measure Infant mortality rate, defined as the number of deaths in children under 1 year of age per 100 000 live births in the same year.
Results The sustained and unprecedented rise in infant mortality in England from 2014 to 2017 was not experienced evenly across the population. In the most deprived local authorities, the previously declining trend in infant mortality reversed and mortality rose, leading to an additional 24 infant deaths per 100 000 live births per year (95% CI 6 to 42), relative to the previous trend. There was no significant change from the pre-existing trend in the most affluent local authorities. As a result, inequalities in infant mortality increased, with the gap between the most and the least deprived local authority areas widening by 52 deaths per 100 000 births (95% CI 36 to 68). Overall from 2014 to 2017, there were a total of 572 excess infant deaths (95% CI 200 to 944) compared with what would have been expected based on historical trends. We estimated that each 1% increase in child poverty was significantly associated with an extra 5.8 infant deaths per 100 000 live births (95% CI 2.4 to 9.2). The findings suggest that about a third of the increases in infant mortality between 2014 and 2017 can be attributed to rising child poverty (172 deaths, 95% CI 74 to 266).
Conclusion This study provides evidence that the unprecedented rise in infant mortality disproportionately affected the poorest areas of the country, leaving the more affluent areas unaffected. Our analysis also linked the recent increase in infant mortality in England with rising child poverty, suggesting that about a third of the increase in infant mortality from 2014 to 2017 may be attributed to rising child poverty.
- public health
- community child health
- health policy
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Contributorship statement DT-R is the lead author and guarantor. DT-R and BB planned the study and led the drafting and revising of the manuscript. DT-R, BB and ETCL conducted the analysis. DT-R, BB, ETCL, SW, TR, PN, CB and MW contributed to interpretation of the data, drafting of the manuscript and revisions. All authors agreed on the submitted version of the manuscript.
Funding DT-R and ETCL are funded by the MRC on a Clinician Scientist Fellowship (MR/P008577/1). SW is supported by a Wellcome Trust Society and Ethics fellowship (grant number 200335/Z/15/Z). BB and TR are supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC NWC) and the NIHR School for Public Health Research. The MRC, Wellcome Trust and NIHR had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. This report is an independent research arising from research supported by the MRC, Wellcome Trust and NIHR. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.
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